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ATTACHMENT B-1 PRE-AUTHORIZATION AND MEDICAL BILLING INSTRUCTIONS Definitions Per Diem Rate - the cost per day per Department offender for all care, included in facility meiical costs housing which is the same or similar care provided to County/City inmates DOC Utilization Management Office (Nurse Desk) - the Department's medical contact that receives, reviews and approves extraordinary medical expenses and non-formulary requests for DOC Offenders. The Nurse Desk is available 24 hours a day via phones at (360) 725-8733 or during normal business hours via email at NurseDesk@doc1.wa.gov Extraordinary Medical Care - medically necessary care that is not commonly available through the facility health services and incurs additional cost. Examples of extraordinary medical care may include, but are not limited to, specialty consults, emergency room care, hospital care, ancillary charges and ambulance services. Extraordinarv Medical Expense - medical expenses that are beyond the medical expenses included in the Base Rate per Diem for in-facility care for Department offenders including high cost/specialty medication for chronic conditions. In-Facility Care - medical care provided to Department offenders as part of the Base Rate per Diem to include over-the-counter medications, routine medical, mental health and dental care, regular medical screenings and emergent medical treatment, identical to services provided to other County inmates. Formulary Medications - medications described in the DOC Pharmaceutical Management and Formulary Manual. Medications in this category are described as medically necessary and require no further approval for use provided the criteria listed in the formulary are met. The formulary is available online at the following link: http://www.doc.wa.gov/corrections/services/docs/formulary.pdf. Medically Necessary Care - medical care that meets one or more of the following criteria for a given patient at a given time: Is essential to li-fe or preservation of limb, or Reduces intractable pain, or Prevents significant deterioration of activities of daily living (ADLs), or Is of proven value to significantly reduce the risk of one of the three outcomes above (e.g. certain immunizations), or Immediate intervention is not medically necessary, but delay of care would make future care or intervention for intractable pain or preservation of ADLs significantly more dangerous, complicated, or significantly less likely to succeed, or Reduces severe psychiatric symptoms to a degree that permits engagement in programming that advances correctional interests, or Is described as part of a Departmental policy or health care protocol or guideline and delivered according to such policy, protocol or guideline, or a a a a a a State of Washington Department of Corrections Kes61.(6) Attachment B-1 Page 1 of 5